Provider Demographics
NPI:1801216304
Name:BOLLIG, CHASE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:
Last Name:BOLLIG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 SANDALWOOD RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1324
Mailing Address - Country:US
Mailing Address - Phone:913-787-5078
Mailing Address - Fax:
Practice Address - Street 1:6546 HAMPTON ROADS PKWY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3185
Practice Address - Country:US
Practice Address - Phone:757-642-4945
Practice Address - Fax:757-642-4945
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11140111N00000X
VA0104-557380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor